Emergency Department Longitudinal Integrated Care

University of Washington40 enrolled

Overview

The overarching goal of this investigation is to develop and determine the feasibility of a multi-component intervention adapted from a collaborative care framework initiated in the ED for patients at risk for opioid use disorder. This study will provide important feasibility information for future studies of ED-LINC. The collaborative care intervention (ED-LINC) will be supported by a novel Emergency Departement (ED) health information exchange platform.

The overarching goal of this investigation is to develop and determine the feasibility of a multi-component intervention adapted from a collaborative care framework initiated in the ED for patients at risk for opioid use disorder. According to the 2015 national survey on drug use and health, an estimated 3.8 million individuals over 12 years of age were currently misusing opioid pain relievers. An additional 329,000 people use heroin. The Emergency Department (ED) is currently at the forefront of this public health emergency and often a place where patients come for treatment of overdose and for treatment of medical problems related to illicit opioid use. Overall, the goal is to establish the feasibility of a multi-component intervention called 'Emergency Department Longitudinal Integrated Care (ED-LINC)' which is guided by principles of collaborative care and is comprised of components that are evidence-based. ED-LINC is initiated from the ED and continues longitudinally for patients at-risk for opioid use disorder.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

Conditions

Opioid-use Disorder Emergency Department

Interventions

ED-LINCBEHAVIORAL

ED-LINC will include 1) A brief negotiated interview at the bedside with an emphasis on motivation to link to services 2) Pharmacotherapy including a discussion of opioid safety, take-home naloxone and initiation of buprenorphine from the ED for participants that are interested and eligible; 3) Longitudinal care management which will proceed for 3-months; and 4) Care plan in the Emergency Department Information Exchange (EDIE) system. This will be coupled with a study cell phone and a weekly supervisory case conference which is consistent with collaborative care principles.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 65 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Aged 18-65 * Patients with at least one risk factor for opioid use disorder via the EMR pre-screen * Patients with score of ≥ 4 on the NIDA modified ASSIST for illicit opioids (e.g. heroin) OR a score of ≥ 4 on the NIDA modified ASSIST for prescription opioids * Currently have a phone * Able to provide a phone number and one additional piece of contact information Exclusion Criteria: * They are incarcerated or under arrest * Non-English speaking * Live beyond a 50 mile radius of HMC * Require active resuscitation in the ED or other clinical area at the time of RA approach * Are receiving palliative care services or hospice care for a chronic illness such as metastatic cancer * Are in the ED or hospital for a primary psychiatric emergency such as suicidal ideation or attempt * Receiving chronic opioid therapy (COT) defined as prescription opioids for most days out of the last 90 days for a chronic pain condition * In the ED for sexual assault

Locations (1)

Harborview Medical Center

Seattle, Washington, United States

Outcomes

Primary Outcomes

Refusal Rate

Percentage of subjects who agree to participate in screening survey prior to determining eligibility status. Potential subjects identified by suspected risky substance use history based on EMR review

Time frame: Baseline

Follow up Completion Rates

The number of participants who completed follow-ups at 6 month time point.

Time frame: 6 months

ED-LINC Intervention and Usual Care Process Outcomes

Number of participants that received at least 1 ED-LINC element

Time frame: 6 months

Implementation Appropriateness

Participants randomized to ED-LINC care were asked about the appropriateness of interventional activities.by rating the agreeability of the statement "ED LINC seemed fitting and suitable"

Time frame: 6 months

ED-LINC Satisfaction

Client Satisfaction Questionnaire (CSQ-8) questions (8-32) will be used to assess satisfaction with ED-LINC, in which greater numbers designate higher satisfaction (32 is maximum or highest satisfaction rating possible)

Time frame: 6 months

Perception of Care Coordination

The Patient Assessment of Chronic Illness Care - Coordination (PACIC-C) questions will be asked of all participants, where greater numbers indicate perception was more coordinated (greater number is better). For the scale, scores must be discrete numbers, with a minimum possible value of 5 and maximum possible value of 25.

Time frame: 6 months

Secondary Outcomes

Substance Use

Data from ClinicalTrials.gov

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